It found that the number of telephone consultations had increased by 24% over that time period, and the number of face-to-face appointments increased by 2.8% - totalling a 7.2% increase in overall patient contacts.

This was at a faster rate than the average increase in list size – 6.2% - suggesting that patients are increasing how often they use GP services.

To meet the increasing demand, more nurses, health care assistants, pharmacists and allied health professionals were found to be employed in primary care between 2015 and 2016 – with a 2.8% increase in nurses and 9.4% increase in other healthcare staff, the King’s Fund found.

It said that this wasn’t completely representative as the practices in their sample were from more deprived areas.

However, the authors concluded: 'The share of activity by different staff groups hasn’t changed significantly in the past three years, with GPs undertaking around three-quarters of the contacts and nurses around a quarter.'

Dr Richard Vautrey, GPC deputy chair, said: ‘GPs are running faster and faster, almost to stand still and cope with the rising expectations and demand', citing an increasing number of older patients with complex conditions having to consult their GP more often.

He added: 'So a patient with diabetes may also have heart disease, may also have lung disease, and all of those conditions need management and now that workload is falling on GPs and their teams.

'What practices are doing is working harder and harder within their existing resources and their resources are not flowing from secondary care into primary care in the way that the workload is.'

The King's Fund surveyed 68 GPs and found that only 16% would describe their financial situation as good, with most responding to pressures by changing the skill mix of their team.

In October smaller Practices that can't survive without a half day closure will go off the extended hours service resulting in a loss of appointments. Of course, higher uptake in neighbouring bigger Practices will make up for part of these lost appointments. The fun will begin when smaller Practices are deserted by the young working people who avail of these early morn or late evening slots moving to register with the bigger Practices. Good for the smaller ones as their weightage won't be dragged down by this young lot who is not considered to have health needs anyway! For every 1000 young patients the formula pays you only for 450.

The registered list in the sample increased 6.2%, the number of contacts in the sample increased by 7.5%. I think the conclusion drawn that contacts are growing faster than population in the sample studied is reasonable, though there is always a possibility that we are seeing better recording of non face-to-face contacts, rather than a true increase in activity.

Outside the sample the population/list size growth is 7.2%. If the number of contacts has grown in the wider GP provider community in the same way as in the sample, you might estimate contact growth of as much as 8.7% in two years in the rest of general practice.

If you look at prescribing item growth over a ten year period, it is around 4.5% annual growth.

It does seem reasonable to conclude that practices are meeting some increased demand, despite a falling GP workforce, largely through skill mix and new ways of engaging with patients.

I see lots of GPs working harder, still putting in discretionary effort and offering amazing value to the NHS.

I guess this is why the current model 'isn't fit for the 21st century' and needs to be completely scrapped and replaced with a more expensive, less efficient 100% salaried service run by the private sector with very few Drs then..now I understand ..it all makes sense.